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Reepithelialization from Stem Cells of Hair Follicles of Dermal Graft of the Scalp in Acute Treatment of Third-Degree Burns: First Clinical and Histologic Study

Zakine, Gilbert M.D., Ph.D.; Mimoun, Maurice M.D.; Pham, Julien M.D.; Chaouat, Marc M.D., Ph.D.

Plastic & Reconstructive Surgery: July 2012 - Volume 130 - Issue 1 - p 42e–50e
doi: 10.1097/PRS.0b013e318254fa21
Reconstructive: Head and Neck: Original Articles

Background: The scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in keratinocyte stem cells. The purpose of this study was to double scalp harvesting in one procedure and to evaluate the capacity of the dermal layer to spontaneously reepithelialize from hair follicle stem cells.

Methods: Two layers of 0.2-mm split-thickness skin graft, a dermoepidermal graft and a dermal graft, were harvested from scalp during the same procedure. Fifteen burn patients were included in this study. Healing of the scalp donor site and percentage of graft taken were evaluated. The Vancouver Scar Scale was used at 3 months and 1 year. Histologic studies were performed at day 0 and 3 months on grafts, and on the scalp at day 28.

Results: Nine patients were treated on the limbs with meshed dermal graft. Six were treated on the hands with unmeshed dermal graft. Graft take was good for both types of grafts. The mean time for scalp healing was 9.3 days. Histologic study confirmed that the second layer was a dermal graft with numerous annexes and that, at 3 months, the dermis had normal thickness but with rarer and smaller epidermal crests than dermal graft. The difference between the mean Vancouver Scar Scale score of dermal graft and dermoepidermal graft was not significant.

Conclusion: The authors' study shows the efficacy of dermal graft from the scalp and good scalp healing.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Tours and Paris, France

Hopital Trousseau, Centre Hospitalier Régional et Universitaire de Tours; and Hôpital Saint Louis, AP-HP, UFR Médecine Paris 7 Denis Diderot.

Received for publication September 23, 2011; accepted January 20, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No outside was funding was received.

Gilbert Zakine, M.D., Ph.D.; Department of Plastic, Reconstructive, and Aesthetic Surgery, Burn Unit, Hopital Trousseau, Centre Hospitalier Régional et Universitaire de Tours, Avenue de la République à Chambray-Les Tours, Tours, 37 044 Cedex 9, France, zakinegilbert@yahoo.fr

©2012American Society of Plastic Surgeons